| NPI | 1972898476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 68625) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: GA 68625) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2016-08-25 |